BASIC PISTOL-LTC-002
REGISTRATION FORM
Please fill out form and return to me with check for $90 PAID _______________________
DATE / COURSE_______________ DATE / BIRTH _____________________________
Please print carefully so your name will be correct on your certificate.
NAME____________________________________________________________________
First
MI Last
STREET___________________________________________________________________
TOWN________________________________________ STATE_______ZIP___________
E-MAIL______________________________ TEL_________________________________
NRA MEMBER #______________________ GOAL # _____________________________
ANY PREVIOUS FIREARMS EXPERIENCE_______________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
SIGNATURE__________________________________________________
Mail to
Charles Davis
P.O. Box 981
Easton, MA 02334
cell 508-364-0544 or 508-238-1586
Instructor Certifications: MSP #BFS00262, NRA #7751050